Medical Bills Underlie 60% of US Bankruptcies
 

National health care is a real possibility for the US. Finally. It is greatly needed.

http://news.yahoo.com/s/nm/20090604/...e_bankruptcy_3

Still, I am concerned. I have great coverage at a most reasonable price, and I worry about what a new national system will look like. Many who have good insurance now may well find themselves dumped into the new public system. Even if the good coverage isn't dumped, I think we can all reasonably expect some taxes to be adjusted to pay for the new system.

What's going to happen to Medicaid and Medicare ?

Would be most interested in hearing from those of you who have public health care how happy you are with it. What are the problems?

We've got two choices:

A) Try to stick with the current system, which is failing. My wife just missed out on a job that she was extremely well qualified for because she didn't say 'no' when they asked if she would need health benefits.

Eventually, those with good coverage will be the very wealthy.

B) Make a change.

I'm an ex-pat American. I've lived in the UK since 1983.

If you're healthy, a national health system is a waste of money. I was healthy until I turned 40. Then, the dominoes started to tumble. First, I was diagnosed with gout. Funny ha ha, unless you have it. Ten years later, a kidney stopped working (infantile) and had to be removed. Ten years later, I was diagnosed with diabetes, followed by a mini-stroke three months later. Two years ago, I had a five-stent, two-artery angioplasty.

I am on constant medication, about 10 pills a day.

The cost for all this?

Zero.

Okay, not zero. We pay 25% tax (in my earning bracket) up to 50% for highest earners. We pay 17.25% "value-added-tax" on almost everything.

If I lived in America right now, I'd be broke and uninsurable.

I was in California in March helping my father in the last days of his life. I saw the best and worst of medical care while there. Mainly, Dad was being treated for a pinched nerve in his back when he was in fact riddled with cancer and tumors. He didn't want to pay for an MRI scan until it was too late to do anything.

The British system is often abused because people demand attention when they have the slightest sniffle. The American system costs so much that you are reluctant to seek attention. I know which I'd rather have.

Yeah. The problems with the US health care system are legion.

Not withstanding the inability of some to get health insurance at all, those with it find once they get sick they can no longer afford it.

Providers/hospitals charge one rate to insurance companies and a different.... often two or three times as high... rate to an individual without insurance. This practice got challenged in court here and guess what... it is legal to charge an insurance company $5,000 and an individual $15,000 for the exact same services. Go figure.

Free
 

I work in an ER. Right now I am at a State Hospital; Part of several institutions that offer "Free" care as well as Medicare, Medicaid and private insurance. We also have a complex of free clinics. To receive free care all you have to do is prove your income falls below a generous level. The clinics have a waiting period from a week to six months depending on the specialty, time of year, hurricanes, etc. On some days 80% of the ER patients are simple sniffles, scams for narcotics, vague complaints....you get the drift. We are required by law to treat them all with our resources. Only after all treatment is completed do the financial people ask the patient for info. Federal law requires this. Even with the present scenario we are pushed to the saturation point often. Patients are also extremely demanding and abusive to the staff. If we have 4 cardiac patients ahead of the sore leg you can bet the sore leg will be screaming non-stop that we're ignoring them. Multiply this by 250/day and you might imagine our situation. The day after "free" care at 25% + 17% tax, we will close. We are not allowed to refuse anyone and if it is free, well, we can't handle the load and I, for one, won't care anymore. Just my $0.02.

I think what you are saying is the current system is not working very well from the provider side either.

The free stuff is far and few in between around here. We do have a University Hospital that will take all comers in the emergency room. I guess they break the law daily... they do require one to sit down with a financial counselor while the patient is waiting to be seen. Insured or not. Eight hour wait last time I was there, even though fully insured and directed to go there by the family doc.

If medication is prescribed, it is up to the patient to get it filled. Often they don't have the money to do so.

Sniffles, etc., are common in the Emergency Room here, too, because that's the only way those without insurance can see a doc.

One would hope that once we have national health care and the poor have access to a doc they won't be clogging up the emergency rooms with non-emergencies. It is an ongoing problem here, to the point that the hospitals implemented a system to require an ambulance to take an injured person to the least crowded emergency room instead of the closest.... and the emergency rooms fight on the radio about who is the least swamped and best able to help the injured person while the ambulance is in route.

I think if the new system could be implemented right, it would take a lot of pressure off providers as well as patients.

I'm here in Massachusetts and everyone here is required to have health insurance at some level and I think it's working great. I have my own through my employer and no one has asks me to give it up for something less. I think we are already seeing how it's forming. There are HSA, health savings accounts, that we pay into just like a 401K. It is tax pre-tax and if any expense out of the HSA is used for medical purposes, it's tax free. In addition, it's portable and use can use the money to invest in the stock market, and companies can choose to match your contributions. So health care will be something that we will have to fund ourselves similar to a 401K and for those that are unable to fund their health care, there will be government assistance.

It's hard to say what will happen to medicare, medicaid and social security but it will probably not be the same 20-30 years from now as it is today.

Suspect you're right. I think social security and medicare will be okay.... changed, but still something viable. Medicaid I worry about. Most think Medicaid is simply health care for the poor, but it is much more than that. Some 80 percent of Medicaid dollars go to long term care, such as nursing homes, intermediate care facilities for the mentally retarded, and increasingly to community alternatives to those placements.

If they kill Medicaid and throw everybody on the national health care program, then the long term care piece is going to have to be reworked. The lobbyist will be fighting it out in congress and no telling what the result will be. Might be better, but change still leaves me uneasy.

It would make sense, I think, that if we have national health care then we wouldn't need Medicaid health insurance as it would be redundant to the national program. Guess Medicare would be redundant, too.

I don't know why Americans (generalisation alert) are so worried about the prospect of nationalised health care. Good lord, compare the affordability and access to care at various socio-economic levels in the US to dozens of other Western nations honestly and I think your only reason for not wanting it would be a vested interest.

The thing about taxes is, you kind of already have the same thing now, except your employer is paying you what they can afford including the cost to them of private insurance to you. It is essentially the same as the government paying for it with your taxes, but because a private employer is paying for it you may not see it as a tax. The big difference is the government is not concerned as much about making a profit when it pays for health care.

It's the way things are marketed to us. There's still a sizable chunk of the population that still thinks they're fighting Communism, and anything that isn't "free market" as the corporations in power define it, must be Communism. We're told that "the market" will take care of it, even though it hasn't, but lots of people still believe it.

One thing about private insurance that's always overlooked: you're only covered as long as you're employed. Yes you can do Cobra, but that's only 18 months and it's even more expensive! The result is that lots of people get sick, lose their jobs, then their health insurance, and find themselves with pre-existing conditions that keep them from getting coverage. It's one of those dirty little secrets the insurance industry doesn't talked about.

here in the Netherlands we have a mixed system. Everybody (well, almost) is insured for 'basic' medical care (i.e. house doctor, dental, hospitalisation, specialist doctors). Private insurance companies provide the policies. Government determines what should be covered exactly and what should not. No one can be refused a basic insurance.
You may choose to upgrade your basic insurance for more coverage such as alternative treatments, more dental work, and so on.

Parallel to this there is income support for disabled, and cost coverage for wheelchairs, adapting housing and so on, by the government. I'm not sure if this suffices for those in need.

- there is debate about for instance should pain relief for chronic illness like rheumatism be covered, should birth control be covered (the pill) each budget year
- the cost for basic insurance can still be pretty steep, especially for single income families.

As a nation, you are absolutely correct. We pay the most, by far, for our health care and get far less than optimal outcomes. An employer based health insurance system that doesn't require employers to provide health insurance is an obviously flawed system that begs for a replacement.

As an individual, though, my health care needs are fully met at a price I can afford (no, it isn't cheap). Who knows what congress will come up with. Just look what they did with prescription drug coverage for Medicare for one example of the machinations they are capable of producing. Another government program, Medicaid, is cost shared between the states and the feds and states have a lot of room to develop their own programs.... the result is 50+ entirely different programs with different populations eligible, different sets of services provided and all subject to change annually depending on state budgets.

Another example... should you become totally and permanently disabled in an accident you become eligible for Medicare, but not for two years. Only option in between is Medicaid which you cannot get until you spend down your resources to less than $2,000 (in my state). Would you buy an insurance policy that you cannot access until you are destitute? Well, our govt did that for us.

For those of you with a national health care program.... does the program cover long term care such as nursing home costs for the elderly?

A temporary anomaly. They'll get to you soon enough. It takes time to screw everyone!
Our government did that? :confused: Medicare and Medicaid are supposed to be there to catch the few who fall through the cracks of the private system. That Medicare and Medicaid need to exist at all is simply evidence that the private system has failed. Neither provides good coverage because Big Business doesn't want the government competing with it. That's the biggest threat to any plan that's gets passed by Congress, which of course is controlled by Big Business.

Yup, govt did that. Did you catch that COBRA is set at 18 months.... but Medicare doesn't kick in till 24 months? And BTW, that's 24 months of drawing Social Security Disability Income (SSDI), which can cause further delays getting that started.

And you really think that these are things that some government paper pusher dreamt up all by himself??? You think that multi-billion dollar businesses and industries just sat by and let these things happen out of the natural course of government business? These businesses had no stake in what government policy was and didn't spend billions to see to it that the rules were made in their favor and not yours?

That's what I am really concerned about. Gosh, if a few thoughtful people were going to sit down and plan a US health care system, then great. If we were going to adopt a system that's working well in Canada or England, then great. What we'll be getting will be fought out in Congress with lobbyists, legislators, and compromises for votes to pass, and on and on. Scares me to death.

Well, on the bright side, many thoughtless people have left government recently. :D

On the other hand, the insurance industry seems to be embracing the idea of an overhaul. That can't be good.

Good point. This is why voters need to more active in their elections. By not participating, we only have ourselves to blame.

I had COBRA at one point but it was way to expensive for me to maintain during the time I was laid off. It sucks that health insurance increases significantly when you can afford it the least.

With a HSA plans, I am still trying to find out if I can use it to pay for health insurance like COBRA if I was to leave my employment but no one I have spoken with seems to know the answer. So I will need to ask a tax advisor about this. It sounds like there are just to many programs floating around but none of them address the basic problem of affordable health care.

That's not an accident. It's the (now) standard business practice of cost shifting. By increasing the price just when you can least afford it, they're knocking people off of health insurance who are likely to be out of work because they have a medical problem. Once they're off, that problem becomes a pre-existing condition, so the bulk of the cost is shifted to the government.

The easiest way for an insurance company to increase profits is to deny claims.

ctwnospam, we really don't agree on financial matter but I do agree with you regarding this point of denying claims. In fact, I have heard people getting bonuses based on the number of claims they can successfully deny. This is greed in it's purest form.

Maybe nationalization isn't all that bad.

They're no different from any other large industry though. I just read about the costs that we're still paying for the Valdez, and that from a company that makes about a billion dollars per week in profit!

http://www.time.com/time/health/arti...887165,00.html

Things like these make it hard to imagine how Big Business can be regarded as being somehow better than government. They're not even good enough to live up to their own relatively small responsibilities!

Jumping in rather late (been staining both sides of a 5 x 65 foot fence), I can say unequivocally that the best public health care systems are inevitably in countries with very high taxes relative to the USA. One of the problems with "free" is that it is inevitably abused -- lots of folks with the sniffles sitting around in doctor's offices or ERs. That clogs the system. The second problem with "free" is that the only way a government can control costs is to limit the number of hospital spaces and doctors. That leads to waiting lists. Having said that, however, at 72, I'm damned glad I live in Canada. Never (as a previous poster mentioned) had a sick day in my life (in 40 years of teaching at University I never missed a lecture because I was sick). At 65 or so, all hell breaks loose. These are supposed to be our "golden years". The only thing golden nowadays is my urine.

Well, it not free but it's perceived as free. I think our whole concept of health insurance is built on the wrong foundation.

Instead of paying doctors to heal us for illnesses, we ought to change it to pay doctors for keeping us healthy and pay them less when we become ill.

with warm regards
Ronald Cross

...And charge the insurance companies for the Medicare/Medicaid/other taxpayer costs when we become "uninsurable" after losing coverage.

.
Interesting and timely thread, Aehurst. :)
Hope to pitch in later.

Now that sounds viable, doctors and insurance companies would then have real motivation for keeping us healthy. :)

All of this is easier said than done...

I think the real question is: Can private insurance provide real value for the money they charge? The answer appears to be no.

I think you're right but it will take a health insurance breakdown similar to what we are seeing in the financial industry today.

It would be nice if Obama can do something about this but he's fighting an up mountain battle with his bare hands and falling once is all that is required to fail.

I think people are beginning to realize that with the current system you're not really insured even if you have a great health plan at work. That's because if you really get sick there are lots of ways that the insurance company can kick you out.

The demand for health care is infinite (especially when pharma companies get to invent new medical conditions). Ergo, health care must be rationed. There are three possible rationing modes: by price, by waiting list, and by personal 'pull'. Pick one.

That's a tough one. Essentially correct I think in the sense that there are limits. At what point do we quit providing health care services? Our insurance companies have simply stated certain things are not covered expenses (translation--not cost effective based on likely outcome), other things have benefit limits.

I think we all understand that near the end of life a point is reached where patient comfort becomes the goal and aggressive treatment ends.

But, when medical attention is appropriate, necessary, and likely to have a good outcome (even if that outcome is to prevent further deterioration), then I see no need to ration health care for any reason.

An excellent point. In countries that are successful in controlling health care costs (while still providing good health care) there is almost always a co-pay, i.e., a small charge to keep the hypochondriacs at bay. Here in Canada there is no co-pay on a doctors or ER visit, but there is on insured drug plans.

Those are the relatively rare cases that they'd like you to pay attention to because it makes things look like the insurance companies are trying to do the right thing with limited resources. The much more common occurrences are the denial of claims based on profit and denial of coverage because of so-called pre-existing conditions.

It's pre-existing conditions where they make a killing. If you have car insurance and have an accident, your current auto insurance has to cover the damage even if you change to another insurer. Try the same with health insurance and it's a different story. You lose all coverage with the old company and the new one won't cover the pre-existing condition. Since it happens frequently with the loss of a job or even a transfer to a different state, that's pure profit for the industry.

During my military years, health care was pretty straight forward. Sick call at 6am and 1pm... be there or be at work. Period. Calling in sick was not an option.

All patients were screened by nurses or physician's assistants... they made the decision about who actually needed care, who needed to see a physician and who just needed a "cold kit" or medicine for the bug of the month. It worked well.... nobody wants to wait hours to see a doc because he/she is the only one who can give you the meds you already know you need or order a test you know you need (e.g. is it strep throat or just sore?)

Amazing how well it worked. Course, under our system the doc cannot bill the insurance company unless the doc actually sees a patient. Hence, you will see the doc no matter how long it takes.

I remember that from RCAF days; not that I was ever sick then, but I was occasionally tasked with taking those who fell out sick from the morning parade over to the infirmary. First question to the assembled was whether all present could walk.

I think a major advance in this regard would be to make much better use of Nurse Practitioners and Midwives. Physician friends of mine make no bones of the fact that lots of their daily patients didn't need to see them.

On the one hand, I hear you. Some years ago I got Giardia lamblia, which you from the South will know about, but which was rare here. Doctors I actually saw were clueless, I was finally diagnosed over the phone by a doctor friend who grew up in Africa. Where, he said, diagnosing and treating Giardia was the job of the nurse, not the doctor.

On the other hand, when the nurse or assistant does the screening, gets it wrong and the patient dies, there's hell to pay. Even when the doctor would probably have gotten it wrong too. I had a very bad experience being blown off by a ER receptionist, who basically did triage based on whether she liked your face or not, when I was really ill. But then, after a six-hour wait, the doctor was no better. TANJ.

The big problem here is that all medical personnel seem to have a presumption in favour of the patient not being really sick. Whether that's related to our having socialised medicine (with a co-pay) or is something to do with the professional culture is a big question that I can't answer here. Bottom line is that it doesn't matter how many degrees the diagnostician has if he or she jumps on the nearest conclusion, smacks its rump and rides it to death; if the only way you can prove you're sick at all is by dying in the waiting room. Which I fully intend to do next time, just to spoil their day.

My physician friends say the same. Despite my more sceptical post regarding screening above, I can never understand people going to a doctor with a common cold. OK, flu can feel like other things, but sneezing, runny nose, weeping eyes, that's a c.o.l.d., by the age of 18 we should all know this; and antibiotics won't do a thing except help breed immune bugs to bite the rest of us. Only two things work: time, and garlic. :D

And I am told a full 80 percent of patients would be fine whether they were treated or not.... that is, the docs are not curing anything, but rather treating the symptoms to make the patient more comfortable while nature takes it course. Course, then there's that 20 % where you get worse or even die without intervention.

Here in the U.S., there is no concept known as the end of life. Most physicians are well compensated for aggressive treatment; they are not well compesated for providing comfort. Unless you have a will specifically stating how you want to be treated during end of the life, the default is aggressive care. You only have to go as far back as the Terry Schiavo case. The woman has no gray matter left in her brain but yet doctors, lawyers, hospitals, politicians all benefited from her being on artificial life support.

Artificial life support wasn't designed to keep people alive indefinitely, its intent was to be used as a life sustaining device until a donor or a procedure is performed that will give the patient a chance at life. Doctors and patients have taken this concept to mean use it at any means to keep me alive even if no procedure will ever be created and there is no chance of a donor. In fact, these systems were tested on younger people and never intended for older people that are dying. This is part of the reason for the high cost of health care. When you really break it down financially, 30-50% of all health cost is charged to the patient during the last 7 to 10 years of the life while it is declining. It's the high cost of keeping someone alive during that last 7-10 years that's the most expensive and the most aggressive. Younger people actually spend less as a whole than older people because they are generally in good health. So when things change, it will most likely be the older people getting screwed and not the younger people.

Yep, this is correct and it's a very good point. The coverage changes from one insurance company to another and there is nothing to stop this foolishness. In the end, you lose because they take all your money and you walk away and you are never covered for what you paid into it. Again, the health care crisis will straighten out this mess. Another couple of decades and we will start to see change. This is the next big bubble. It's unfortunate that it will occur with the baby boomer generation as they will have a rude awakening!

In Terry Schiavo's case, the "artificial life support" the doctors eventually removed was the feeding tube. They let her starve to death. Not because the feeding tube wasn't functioning well, but because others made the determination that her particular life was not worth living given she was, apparently, unaware of her surroundings.

While I don't particularly disagree with the eventual decision in the Schiavo case, there are a million additional examples of people who live life with the help of "artificial life support".... a feeding tube, a ventilator, a mechanical heart valve.... who are aware of their surroundings. Many are quite capable of making a decision to end life but choose not to do so. Others have some degree of mental impairment as a result of traumatic brain injury, stroke, etc., that may or may not be able to make that decision rationally or at least not from the same perspective as a person without their impairment.

Others are born with a condition that requires lifetime "artificial life support" such as a feeding tube or ventilator.

Certainly these situations are tragic and very expensive, but I am not ready to go down the road of medical personnel making determinations as to which life is worth living and which life is not. It's only a short skip from there to terminating non-productive lives, terminating babies born with physical or mental defects, or terminating the elderly when they can no longer care for themselves. All life is a terminal condition.

The living will is one way around some of these issues, but there are many issues with those as well.... probably better not to get into that. In any case, the bean counters at the insurance company should not make these decisions. The heirs to the estate should? The beneficiary on the insurance policy should? I think leaving these decisions to the family is the best we can do, and I think by and large the family will make the right decision. In any case, these decisions should not be about dollars and cents.

@AEH: It is therefore very important as you approach an age in which an end-of-life situation might arise, i.e. into your 70s when strokes, cancer, or a heart attack might leave you helpless, that you and your spouse and/or your kids have a very clear understanding of where you stand on the matter. You really should prepare a "Living Will"; a signed and witnessed document outlining your preferences. Mine goes like this:

I opted to forego the living will for the time being. The wife is well aware of my view on these things and will pull the plug when appropriate. Yes, we have discussed it in depth.

There are just so many gray areas one might find themselves in and any document containing words is subject to disagreement and the refusal of others to participate as desired.

If the document is provided to a hospital while you are hospitalized for a serious condition, the hospital will annotate your records with a "DNR" order. This essentially means your wish is to die... so should you be drowning in your own saliva, totally unrelated to the condition you are hospitalized for, you will not be suctioned and you will die from drowning. Said another way.... while the staff is discussing whether or not your condition warrants pulling the plug, you may well drown.

You're thinking pull the plug when all hope is gone. The hospital/doc is thinking DNR. There is a difference.

This whole arena is a huge issue for people with severe disabilities.... many without disabilities would rather die than spend their lives mentally impaired or unable to care for themselves, but I promise you those with severe disabilities DO NOT think that way. In your mind, you are thinking of ventilator support, comatose with no chance of recovery, unaware of your surroundings, etc. But, can you be sure the medical folk making that call have the exact same thing in mind?

It's all just too subjective for my liking. I'll let the wife pull the plug.... and I am confident she will do just that!

My wife and three kids understand where I stand on this and I'm fairly confident they will appropriately "pull the plug". I prepared the document as ammunition for them should they meet with resistance. DNR is exactly what I have in mind, saliva or not.

Further, I've had personal experience with this issue: my mother, who didn't want to be, as she put it years ago, "preserved beyond her Best By date".

I volunteer a lot of time with organizations that support those with a developmental disability.... mental retardation, autism, cerebral palsy and similar. It is a whole different perspective when you're making that decision for a frail, elderly parent than when the decision is being made on a child.

Some of these children have a standing DNR order even though they are no where near death nor have a terminal condition. Rather, it is based on the parents' perception of their quality of life and their personal values. The one truth I've learned is there is no answer that is right for all, all the time.

My mother-in-law died of cancer. She didn't want to die in a hospital or surrounded by strangers, so we moved her in with us. She passed peacefully after a few months, connected to a self medicating morphine pump.

I guess we all know how the book ends, and it is often not pretty. Quick is better I think, but that is a personal opinion.

I've asked earlier but got no response.... for those of you with a national health care program... does your program cover long term care such as a nursing home for the frail elderly who can no longer care for themselves? Or those born with severe disabilities who will never be able to care for themselves?

That's two questions.

1) Frail Elderly: in Nova Scotia, this is based to some extent on ability to pay (by the individual -- not their family), but if one spouse is in care of a nursing or assisted living home, the other cannot be forced to sell their home or car to pay, i.e., fixed assets like those are not counted in "ability of the individual to pay".

My mother, who was not poor, paid. If your money runs out, then the Province pays for the duration. There are nonetheless lots of horror stories because there is a substantial shortage of spaces available and folks must sometimes be placed fairly far from home. My brother and I live 100 miles apart but we managed to place my mother in a home half way between us.

My mother-in-law lives in an assisted living facility (a converted motel, actually) has her own room and things in it, but it has a dining hall and a nurse on duty all the time. She pays $2400/month from a teacher's pension and Canada Pension funds plus income from the sale of her home. Seems to be completely content with the arrangement.

2) There is substantial assistance for the severely disabled, but if they are not institutionalized, their parents bear a large part of the burden. Their health care costs are covered, but typically not some of their extraordinary expenses like special treatments that are not approved by the Province or out-of-province treatment.

Not entirely unlike our system (Medicaid) it would seem, except if the state pays they are going to own the home in the end. But, the surviving spouse will be permitted to continue to live there until their death. If the home is sold, the state will recoup their money from the sale.

I was under the impression that some of the national health care plans provided full coverage from birth till death..... apparently not so.

What happens in the case your wife dies before you? I hope you and her had this discussion.

Yep, a heart attack is quick and maybe painless. A few people that have survived heart attacks don't remember when they became unconscious. Most people would love to just die in their sleep as this is thought to be somewhat peaceful. However, based on the data from the World Health Organization, most people in the industrialized world will not be so lucky. Most people go through a period of 7-10 years of declining health before they die.

I simply don't know the position on terminal care here well enough, so I'll mail Stones and ask him to cover it.

The survivor will do a living will. Don't trust the kids.:)

My brother is in on the deal as well.

Absolutely. Garlic keeps contagious people at a safe distance -- although that is not the reason usually offered as to why it wards off colds. ;)

I'm surprised no one has mentioned "Sicko." Michael Moore can certainly cherry-pick his facts (he definitely rose-tints the NHS) but he's no Satan, either. Lots of things to think about.

Well, isn’t Western medicine at heart allopathic, i.e. focusing on symptom treatment? Which as far as I understand it often means treatment at odds with what the body is trying to do to cure itself...

The root cause is often unaddressed.

:D We do the same with the economy, education, etc.

So let the games begin.

http://news.yahoo.com/s/nm/20090609/...are_congress_7

Three competing initiatives, with the biggest difference being some want a public insurance option and others want simple insurance reform with no public option. And with an estimated implementation cost of over $1 trillion.

A trillion here, a trillion there.... no biggie in today's world.:)

That was definitely an eye opener. Made me appreciate what we have here in Aus. Also made sense of all those "we have cheap drugs" spams I get. I never understood why someone would be tempted to buy medications off some anonymous shyster.

What do you mean? I think that's where the NHS gets all its drugs!

Not quite as bad as it seems.... both Walmart and Wallgreen will fill a 30 day prescription of any generic medication for $5 or less. It's only the more recently developed meds where the pharmaceutical corps still have a monopoly that things get outrageous. Monopolies tend to do that.

So if you can get by on yester - year's state of the art meds, no problem. The recently developed drugs do, however, work better and access to them does increase life span.

Yikes! You do know that the only way they can do that is by massive cost shifting, right? Walmart in particular is infamous for legally not paying taxes. That means that if there's a Walmart in your town, you're probably paying higher taxes because small businesses that used to pay taxes have left, and Walmart doesn't pay its share. Heck of a free market we've got here, isn't it?

Walmart tries to legally avoid paying taxes? Well, so do I. It's the great American pass time. It's not a loophole if your well paid lobbyist got it put into law for you.

In any case, here you go. http://www.walmart.com/catalog/produ...ct_id=10179618

Are you deliberately missing the point? I said it was legal to emphasize the fact that it's accepted because of their ability to manipulate the system, which effectively renders any idea of a "free market" moot. What's more, it allows them to LIE to you! They tell you that you're getting your prescription drugs for $4, then make you pay more in taxes because of it! Your real cost is many times that $4 fee.

Your first sentence is pushing it, CWT.

Is this article what your oft sought-after "free market" is about?

http://en.wikipedia.org/wiki/Free_market

From your link:

The laws enacted by companies like Walmart constitute government intervention! Tax rebates are subsidization, and Walmart uses those to drive other businesses out. It's as far from a free market as you can get!

Not sure I agree with what you're saying. If I bought the meds down the street for $10, would my taxes go down? I don't think they're they are telling a lie.

I think every single business out there manipulates every thing they can legally manipulate. If society thinks they shouldn't be doing that, then society should pass a law making it illegal.... otherwise, it's just maximizing market potential. It's not at all different than Kroger giving coupons or discounts to regular customers.... or a 7-11 selling gas 2 cents cheaper than their competition, etc.

Certainly agree that corporations have tax loopholes big enough to drive freight trains full of cash through. And one would be foolish not to take advantage of what the Congress gives you by way of tax breaks.

The fact that you and I don't like it is irrelevant.

But isn't this what truly got Wall Street in trouble, i.e. little or no regulation?

Loopholes are quirks in the law that everyone can take advantage of. That's not at all what's going on here:
You and I can't get these, and neither can small businesses. Look at the list of items that define a free market:

1. no regulation -- Walmart is making their own rules, so this is effectively true for them, but not their competition.
2. no subsidization -- Massive subsidization (Couldn't sell $4 prescriptions without it!)
3. no single monetary system -- We still have that!
4. no governmental monopolies -- By subsidizing Walmart at the expense of small businesses, we effectively grant Walmart a government sponsored monopoly.

The point here is that Walmart is part of the problem with healthcare in the US, not the solution.

Nobody's saying that an ideal free market would be ideal in reality. Regulation is necessary to create and maintain a free market because without it a few powerful groups will collude to control the market. That's the problem with the entire US economy: we pretend that we have a free market when the truth is that a relatively few corporations have far too much control.

A contradiction in terms.

Not really. Markets can't exist without rules. The important thing is to keep the marketers from being the rule makers.

Can we please get back to the medical topic as there is already lots of threads on free market stuff.

It's all the same thing, really. Cost shifting is a nasty way to do business, and it's become standard practice throughout the economy. If health care is different it's because there's more of it in health care. Too many insurance plans and not enough regulation. Much of what regulation does exist is too much in favor of the insurance companies.

For the past 50 years, the single largest problem with US health care is we have lacked the courage to throw the private insurance model out the window and start with a new system. Politics (read that as money and influence) has always been the problem.

I fear that as the games begin with three opposing plans, our courage will again be tested. Just hope we fare better this time round and we actually address actually providing health care for everyone.

Still think Hillary had a better plan.

Anything short of health care for all will leave holes that will eventually be exploited by you know who.

Whoa! Am I seeing the birth of a new and more radical AEHurst? :cool:
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Hardly. I do think the government that governs least, governs best. But it's hard to ignore the facts.... the private sector has had decades to make health care in the US work and has failed miserably even at an extravagant cost. Time to build a system that works.

And frankly, I'm not too far from coming to the same conclusion on energy. Not quite there yet, but close.:)

I have more hope for energy because as the technology improves it cannot remain centralized. With health care, most of the power will either be with a small number of insurance companies or with the government. I'd trust the government over a small number of companies any day of the week. With energy, we have a small number of producers now, but that will change as solar and wind expand into individual businesses, homes and cars.

How about do it yourself health care? You provide the diagnosis, they provide the treatment.

http://www.cnn.com/2009/HEALTH/06/11...sis/index.html

That's kind of what we have now! Doctors today need to be businessmen, and complicated diagnosis is time consuming. ;)

What about genetics, medical health and bankruptcies?
 

Sounds like she's lucky because she's finding out early (which means no serious complications) what she developed and it's treatable. It's when you developed a serious complication due to something diagnosed late is when it can hit you in the pocket book pretty hard. Which brings me to another issues involving bankruptcies due to illnesses.

In terms of people going bankrupt due to medical care, would it matter if people were genetically tested early in life and told their pre-dispositions to diseases and other ailments and then given specific advice on prevention and treatment for those things that they are genetically susceptible to developing? Would this help financially? Would it also help us to focus more of our research on what may harm the majority of the population as a whole in let's say 30 to 50 years down the road. For example, if we knew that most children today are being born with autism, would it be worthwhile to federally fund such projects so that we could stop, treat, prevent, or reduce it's occurrence?

With our current system, I suspect that information would leave one unemployed and uninsurable. Certainly would be useful in another system, though. Still wouldn't want that info available to anybody but me.

It likely that we will be in another system in the next couple of decades. I was thinking along the lines of national health care. In a national health care system, information like this can be used to keep cost down. Of course if it's collected by the government, all identities are removed from the data.

If you wouldn't want anyone to know, then you probably wouldn't do genetic testing unless it was an in home kit which they are starting to sell these days.

Pointing the bone? Probably a cheaper way would be to have greater education (perhaps starting very early in school) about the healthiest ways to live for everyone. Surely the recipe for avoiding heart disease for those with a susceptibility is the same as for those without? But you are right prevention is cheaper than cure. I can't remember where, but I have seen studies equating dollar amounts spent on prevention being X times more useful than the same amount on cure. Hence all the anti-smoking push worldwide (we've had that discussion here).

Exactly why my health insurance pays a considerable amount for me to have massages and chiro and counselling and dental checkups. Because their actuaries have calculated that it's cheaper for them to pay for that now, than to pay for what may or may not happen as a result of muscle strain or stress later in life. And I'm very happy to take them up on their offer too :)

"The Economist" this week has a pull-out section on the American economy that covers this kind of base. I think it supports CWT's general line. Some interesting material about how runaway health costs depress wages; plus non-political aspects like the almost total lack of digitisation of medical records, which means it's easier for a doctor to do an expensive test again than to find the results of the last one.

Here, by the way, no one gets to see a specialist without going through a primary-care physician first. This keeps costs down, because specialists are the people who have hammers and so see everything as a lucrative nail.

Here's a fairly current article on the issues and potential costs, benefits, etc.

http://www.sfgate.com/cgi-bin/articl...MNMA17VE77.DTL

It concerns me greatly that all the discussion is about "costs" and things like taxing medical benefits.... read that as a tax increase. The problem, in my view, is not so much that US health care is expensive, but rather it is simply a poor model that leaves 46 million uninsured and that doesn't get the job done even though it is very expensive.

It confuses me greatly that at one point we can save billions by fixing the system, but in the following paragraphs it states that it will cost $1.5 trillion over 10 years. Huh? Are we going to save money or spend a lot more?

No plan will be affordable if we continue to allow foreign corporations to destroy the country. We like to think that health care costs have risen dramatically, but while they have risen it's the fact that wages have dropped that hurts everything from car and home sales to small businesses. Lack of health insurance is just another symptom of the real problem.

It seems the Senate's version of what our health care plan will look like is in the books.

http://news.yahoo.com/s/ap/20090703/...RlcnNlbmF0ZWg-

I think this thing is dead in the water absent some really serious revisions. Fixes some obvious problems, like guarantees everyone can buy insurance regardless of pre-existing conditions and at the same price as everybody else. Somehow, I just don't see that working without a government plan (strongly opposed by Republicans).... we really going to make a private insurance company take on a million dollar vent dependent patient just because they applied? Even though a handful of patients like that will push the company into bankruptcy? I just don't see that happening even if the insurance companies can pass the extra costs on to all their policy holders.

Partially paid for with fines.... like billions of dollars in fines on individuals who don't think they can afford insurance. Right.

Partially paid for with reductions in Medicare (public insurance for elderly) and Medicaid (public insurance for poor and disabled) spending. Again, right. How you gonna do that? Only a couple ways... cut covered services, ration care, cut provider reimbursement to the point they won't participate or cut the number of people eligible. This one scares me.... gives the appearance this whole thing is a scam and they really aren't serious about doing any of it or are intentionally hiding the costs.

Just don't like the way this is headed and I am concerned with what appears to be an intentional withholding of details (translation... details to be worked out later by committees or government agencies.... devil is in the details).

Public will never understand this proposal.

It's also going to be partially paid for by saving the money that currently gets spent (by the government) in costly emergency rooms where the uninsured must go now for treatment.

The biggest problem I see here is that the insurance industry is successfully marketing its view of covering people as an unnecessary expense. The reality is that when the insurance companies avoid covering people they shift the burden onto the tax payers. If taxpayers are going to pay the health costs anyway, then there's no reason to let the insurance industry make a profit on the health industry.

I don't like the way this is headed either. Because the insurance industry isn't screaming their heads off about this I'm afraid the tax payer will continue to be ripped off.